British Journal of Renal Medicine - 2005

Comment: Total recallJohn Bradleypp 4-4NHS clinics remain as popular as ever. Outpatient attendances in England rose from just over 40 million in 1995–96 to just over 44 million in 2001–02. In 2004–05, 44,748,144 patients attended NHS clinics in England. Of these, 70% were follow-up appointments initiated by the hospital specialist.

Managing general nephrology in a nurse-led clinicAlexander V Crowe, Julie Warrington and Graham J Kemppp 6-8The detection of chronic kidney disease (CKD) is increasing and, consequently, patients are accumulating in nephrology clinics. As CKD requires lifelong monitoring, these clinics are progressively congested with follow-up review patients. It can be extremely difficult to discharge these patients to primary care because of the variable and frequently unknown resources available in the community to support the monitoring of blood pressure, and blood and urine tests. This has a major influence in prolonging waiting times for new nephrology referrals.

Preparing children for kidney transplantation through playKerrie Waby, Kim Helm and Alan R Watsonpp 9-11Children and young people who require renal transplantation have already been subjected to a large number of potentially painful procedures, including numerous venepunctures. Research in our unit has demonstrated the value of preparing both children and families so that positive coping strategies can be developed.

Renal biopsies – solving the myths for the uninitiatedShaun Summer, Terrence Cook and Alan Salamapp 12-14A 24-year-old lady presents to a renal clinic after a routine medical investigation found her to have active urinary sediment (protein 3+ and blood 3+) on urine dipsticks. She has no history of renal problems and complains only of lethargy and occasional joint pains. Routine blood investigations reveal a normal full blood count; a marginally elevated serum urea (8 mmol/l); creatinine (100 µmol/l); albumin (34 g/l); and a calculated glomerular filtration rate (GFR) of 57 ml/min/1.73 m2. Formal quantification of her urine finds 1.3 g of protein per litre. After a departmental renal ultrasound shows two normal-sized kidneys, with no structural abnormalities, she is referred for renal biopsy.

What I tell my patients about conservative management of their established renal failureKatie Marshall, Claire Hodson, Maria da Silva-Gane and Paul Warwickerpp 15-18A multidisciplinary approach (where healthcare and other professionals from different fields treat you) is essential to provide a comprehensive and successful programme dedicated to the needs of patients with established renal (kidney) failure, who are to be managed conservatively (that is, without dialysis or a transplant). In this article, we have concentrated on the conservative management of patients who have never been dialysed, rather than the care of patients choosing to withdraw from dialysis.

Water, salt and dry weight – an unholy trinityNicholas A Hoenich and Catherine Pearcepp 19-21Many dialysis patients lack the ability to produce urine, and the fluid ingested as part of their diet or produced metabolically requires removal during dialysis. Historically, the patient’s weight at the end of a treatment represented the ‘dried out’ weight but, with the advent of shorter dialysis schedules, the attainment of this weight, as well as establishing its value, has become difficult – particularly in patients whose interdialytic weight gains are high. Furthermore, demographic changes in patient populations mean that many elderly patients are being treated whose cardiovascular systems are impaired, resulting in poor tolerance of fluid removal.

Joint conference could shape the future of renal careSteve Smith and John Feehallypp 22-22The British Renal Society (BRS) and the Renal Association (RA) will join forces next year and hold their first joint conference in Harrogate, 3–5 May 2006. This is a fully integrated meeting with a range of sessions that will provide plenty of interest for the whole multidisciplinary team. The programme committee has done an excellent job in putting together a well-balanced programme. There will be plenary sessions on end-of-life care, dialysis access, the history of dialysis, bone disease, salt and water balance and acute renal failure. Other topics include chronic kidney disease and pregnancy in renal disease, and there will be various clinical science sessions.

Exploring non-heartbeating donor programmes worldwideDavid Talbotpp 24-26The increase in patients awaiting transplant and the slow reduction in donation rates was brought into sharp focus in 2000 with the Alder Hay organ retention scandal. When the news of this broke there were many speeches and articles of condemnation, and at the same time organ donation seemed (for those of us in it) to halt. Probably sensing this, the government pledged extra funding to the new UK Transplant to promote donation and transplantation.

Factors contributing to poor compliance with medicationCarol A Candlish, Lynsey A Tiplady, Roderick J Beard and Mary McHughpp 27-31Compliance has been described as the degree to which patient behaviour corresponds to the therapeutic recommendations of the healthcare provider. Poor compliance includes missing appointments, discontinuing treatment, modifying a regimen, inability to follow clinician instructions and self-discharge from hospital or treatment. Rates of compliance in chronic illness have been shown to diminish over time and it is well known that, as the number of medications increases, compliance decreases. Published figures suggest that in haemodialysis (HD) patients non-compliance with prescribed medications ranges from 30 to 60%.

The British Journal of Renal Medicine was previously supported by Baxter Healthcare from 2011 to 2013, by Sandoz in 2011, by Shire Pharmaceuticals from 2006 to 2011, by Ortho Biotech and Shire Pharmaceuticals in 2005, by Ortho Biotech from 2000 to 2005 and by Janssen Cilag from 1996 to 2000.

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